1. Dr. Johnson Alex College of Medicine, DAU
Depression
Dr. Johnson Alex
College of Medicine, DAU
Depression
7/4/2019

2. Objectives At the end of the class students should be able to
Define the depression disorder
Explain the symptoms of depression
Describe the etiology and management of depression
Depression
7/4/2019

3. Mood Disorders Two key emotions :
Depression: Low, sad state in which life seems dark and its challenges overwhelming
Mania: State of breathless euphoria or frenzied energy
Clinical depression is one of the most common and debilitating of the psychiatric disorders.
Lifetime prevalence has been estimated at 16.2% and rates of comorbidity and risk for suicide are high.
Depression
7/4/2019

4. How Common Is Depression?
Around 8% of adults in the U.S. suffer from severe unipolar depression in any given year
As many as 5% suffer from mild forms
Around 19% of all adults experience unipolar depression at some time in their lives
The prevalence is similar in Canada, England, France, and many other countries
The rate of depression is higher among poor people than wealthier people
People of any age may suffer from unipolar depression
Women are at least twice as likely as men to experience severe unipolar depression
Lifetime prevalence: 26% of women vs. 12% of men
Among children, the prevalence is similar among boys and girls
Approximately 85% of people with unipolar depression recover, some without treatment
Around 40% will experience another episode later in their lives
Depression
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5. Prevalence of Depression in Saudi Arabia
Conducted study from 2000 to 2002 among 632 patients
Frequency of depressive disorders were 19.3 % and the age group between 20-49
Female Male ratio was 1.7: 1
Depression
7/4/2019

6. What Are the Symptoms of Depression?
Emotional symptoms
Feeling “miserable,” “empty,” “humiliated”
Experiencing little pleasure
Motivational symptoms
Lacking drive, initiative, spontaneity
Between 6% and 15% of those with severe depression die by suicide
Behavioral symptoms
Less active, less productive
Cognitive symptoms
Hold negative views of themselves
Blame themselves for unfortunate events
Pessimistic
Physical symptoms
Headaches, dizzy spells, general pain
Five main areas of functioning may be affected:
Symptoms may vary from person to person
Depression
7/4/2019

7. Depressive Disorders (Based on DSM-V Classification)
Disruptive mood dysregulation disorder
Major depressive disorder
Persistent depressive disorder (dysthymia)
Premenstrual dysphoric disorder
Substance/medication-induced depressive disorder
Depressive disorder due to another medical condition
Other specified depressive disorder and unspecified depressive disorder
Depression
7/4/2019

8. Disruptive Mood Dysregulation Disorder
Severe recurrent temper outburst manifested verbally (e.g. verbal rages) and behaviorally (physical aggression toward people)
The temper outbursts are inconsistent with developmental level.
The temper outbursts occur, on average, three or more times per week.
The mood between temper outbursts is persistently irritable or angry most of the day, nearly every day, and is observable by others (e.g., parents, teachers, peers).
Criteria A-D have been present for 12 or more months Throughout that time, the individual has not had a period lasting 3 or more consecutive months without all of the symptoms in Criteria A-D.
Criteria A and D are present in at least two of three settings (i.e., at home, at school, with peers) and are severe in at least one of these.
The diagnosis should not be made for the first time before age 6 years or after age 18 years.
By history or observation, the age at onset of Criteria A-E is before 10 years.
There has never been a distinct period lasting more than 1 day during which the full symptom criteria, except duration, for a manic or hypomanic episode have been met.
Depression
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9. Major Depressive Disorder
Depression
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10. Persistent Depressive Disorder (Dysthymia)
Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years.
Presence, while depressed, of two (or more) of the following:
1. Poor appetite or overeating.
2. Insomnia or hypersomnia.
3. Low energy or fatigue.
4. Low self-esteem.
5. Poor concentration or difficulty making decisions.
6. Feelings of hopelessness.
Depression
7/4/2019

11. Persistent Depressive Disorder (Dysthymia)
During the 2-year period (1 year for children or adolescents) of the disturbance, the individual has never been without the symptoms in Criteria A and B for more than 2 months at a time.
Criteria for a major depressive disorder may be continuously present for 2 years.
There has never been a manic episode or a hypomanic episode, and criteria have never been met for cyclothymic disorder.
The disturbance is not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.
The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g. hypothyroidism).
The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Depression
7/4/2019

12. Premenstrual Dysphoric Disorder
In the majority of menstrual cycles, at least five symptoms must be present in the final week before the onset of menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week postmenses.
One (or more) of the following symptoms must be present:
1. Marked affective lability (e.g., mood swings: feeling suddenly sad or tearful, or increased sensitivity to rejection).
2. Marked irritability or anger or increased interpersonal conflicts.
3. Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts.
4. Marked anxiety, tension, and/or feelings of being keyed up or on edge.
Depression
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13. Premenstrual Dysphoric Disorder
C. One (or more) of the following symptoms must additionally be present, to reach a total of five symptoms when combined with symptoms from Criterion B above.
1. Decreased interest in usual activities (e.g., work, school, friends, hobbies).
2. Subjective difficulty in concentration.
3. Lethargy, easy fatigability, or marked lack of energy.
4. Marked change in appetite; overeating; or specific food cravings.
5. Hypersomnia or insomnia.
6. A sense of being overwhelmed or out of control.
7. Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of “bloating,” or weight gain.
D. Clinically significant distress in work, school, usual social activities or relationship with others
E. Not related to other disorders or attributable to physiological effects of a substance
Depression
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14. Etiology of Depression
Genetic factors- 37% MDD & Higher for women than men
Neurotransmitters
MDD- low levels of norepinephrine, dopamine, and serotonin
Depression
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15. Etiology of Depression
Brain structure – diminished activity of prefrontal cortex, anterior cingulate, hippocampus and amygdala
Brain Imaging
Structural studies- Focus on number of or connections among cells
Functional activation studies- Focus on activity levels
Over activity of HPA axis- release of cortisol (stress hormone)
Depression
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16. Etiology of Depression
Life events- death of close relative, separation, divorce, migration etc.
Lack of social support from family/society
Interpersonal problems and difficulties
Behavior theory- learned helplessness, attributional reformulation, & Hopelessness
Cognitive theory (Aron T. Beck)
Negative triad (negative view of self, world, and future)
Negative schema (based on the past experience) and
Cognitive biases (negative automatic thoughts)
Depression
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17. Cognitive biases
Overgeneralization- making sweeping conclusion based on a single event. (E.g. my friend is not spoke to me yesterday, because he is hating me broke the friendship.
Selective abstraction- Drawing conclusions on the basis of just one of many elements of a situation.
Personalization- attributing personal responsibility for events which are not under a person’s control
Minimization- downplaying the importance of positive thought, emotion or event.
Magnification- blowing things out of proportion
Arbitrary inference- drawing conclusion when there is little or no evidence
Depression
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18. Thank you
Depression
7/4/2019